Background Acute kidney injury (AKI) is a serious problem during pregnancy. Once occurred, it causes devastating maternal and fetal outcomes. In developed nations, the trend of pregnancy-related AKI (PRAKI) is on a decline due to the advances in obstetrics care and the legality of abortion. On the contrary, this situation remains a major health problem in the developing countries. Aim of the work in the present study, we determine the incidence, etiology and outcome of PRAKI in a sample of Egyptian patients. Methods Prospective observational study to determine the incidence, etiology and outcome of PRAKI was conducted over a period of one year from January to December 2017 at Ain Shams university obstetrics & gynecology hospital. Patients were enrolled in this study once PRAKI at antepartum as well as postpartum period was diagnosed according to the definition of KDIGO AKI guidelines diagnostic criteria Results During the period of the study a total of 13050 obstetric patients were admitted in Ain Shams university obstetrics & gynecology hospital. In total, 78 patients met the diagnostic criteria of PRAKI representing an incidence of 0.59% (78/13050). Pre-eclampsia & sepsis were the two most common causes of PRAKI, others were dehydration, postpartum hge, antepartum hge, UTI, proteinuria for investigation, SLE activity, DIC, TTP, Acute fatty liver of pregnancy, eclampsia, eclampsia complicated with HELLP syndrome, eclampsia with acute fatty liver of pregnancy, HUS, hyperemesis gravidarum, hypertensive emergency. Fifty five patients (70.5%) received conservative management. Hemodialysis was initiated in twelve patients (15.3%) based on standard indication (azotemia, oliguria volume overload, hyperkalemia and/or metabolic acidosis). Hemodialysis and plasma exchange was used for four patients (5.1%). Plasma exchange was indicated for seven patients. None of the patients received peritoneal dialysis or continuous renal replacement therapy. The ultimate evolution was good in 47 (60%) patients with complete recovery of the kidney function.14 women (17.9%) had an increased serum creatinine level at discharge for follow up at outpatient clinic. 6 patients (7.6%) had kept with advanced renal failure requiring hemodialysis. There were 11 cases of death, mortality rate was 14%. Conclusion AKI during pregnancy poses a challenge for physicians. In view of the multifaceted problems that potentially complicate pregnancy in women with AKI. Fortunately, with ongoing improvements in obstetrical care, multidisciplinary approaches comprising nephrologists, obstetricians and neonatologists maternal and perinatal mortality in this setting are largely avoidable. Therefore early recognition of signs and symptoms, close monitoring in high risk cases, early referral and a multidisciplinary team management could potentially prevent progression to higher stages of PRAKI and reduce morbidity and mortality.

Background Screening is an important strategy to address the burden of chronic kidney disease (CKD) in diabetic population. International clinical guidelines recommend CKD screening for individuals with risk factors such as diabetes using laboratory assessments of glomerular filtration rate (GFR) and urine albumin excretion. To assess the implementation and outcomes of screening programs for CKD in type 2 diabetic patients. Patients and methods A cross-sectional study was conducted that included 200 adult type 2 diabetic patients in Alagouza Hospital. Patients on hemodialysis and those with type 1 diabetes mellitus were excluded. Patients were screened for CKD using urinary albumin/creatinine ratio and average estimated glomerular filtration rate. Patients with CKD were further investigated for extrarenal diabetic complications such as peripheral vascular disease and cardiovascular complications. Results Overall, 55% of the studied patients were males, with a mean age of 60.09±8.55 years. Among diabetic complications, nephropathy was the most common (53%), followed by history of neuropathy (44.5%), and retinopathy evidenced in fundus examination (34.516%). History of stroke presented in 17.5% of patients. Peripheral neuropathy, retinopathy, and stroke history were more common in nephropathic patients compared with patients without nephropathy (62/27, 61/8, and 22/13, respectively). Patients with evidenced nephropathy who were further investigated for extrarenal diabetic complications showed peripheral vascular disease in 32.1% (34 patients), with three patients undergoing amputation. Heart failure and ischemic changes were seen in 17.9% (19 patients). Conclusion Screening of diabetic nephropathy in patients with type 2 diabetes mellitus helps in early treatment and avoids its more serious complications such as progression to end-stage renal disease and other extrarenal diabetic complications.

Background: Coronavirus disease 2019 has significantly affected the provision of medical services. The hemodialysis (HD) facilities together with other medical facilities faced challenges in safely providing clinical care to patients and staff during the pandemic. Objective: To describe our experience during the COVID-19 pandemic as regard infection, mortality rate, clinical manifestations, illness duration and the efficacy of our local infection control measures in our Hemodialysis Unit,

Background as one of the most important long term complications of diabetes, Diabetic nephropathy is the major cause of end stage renal disease and high mortality. Purpose to identify the pattern of microRNA-377 changes specific for diabetic nephropathy in diabetic patients and in patients with chronic kidney disease of different etiology. Patients and Methods the study was conducted from 2016 to 2018, included 50 patients for analysis of MicroRNA-377 and its control gene U18 at El Demrdash Hospital Ain shams university and Quessena Hospital El Monfia. The miRNA-U18 was analyzed for normalization of correction ratio. Results the results of our research found that the highest median IQR of miR-377 was significantly present in DN stage 1&2 and the lowest median IQR was significantly present in CKD stage 1&2, and there was significant difference between group 1 (DN stage 1&2) versus group 2 (DN stage 3&4), group 3 (Diabetics without nephropathy) and all stages of CKD. Conclusion in diabetic nephropathy stage 1&2, serum miR-377 was highly significant increased more than diabetics without nephropathy, diabetic nephropathy stage 3&4 and all satges of CKD.

Background According to the WHO there are 185 million people infected with HCV in the world.Egypt has the highest prevalence of hepatitis C virus (HCV) in the world reaching 13% equating to an estimated 12 million Egyptians . HCV is one of the main causes of liver cirrhosis and hepatocellular carcinoma.HCV can develop kidney disease because of extrahepatic manifestations of HCV or as a disease process independent of the HCV infection.In addition, hemodialysis has been a risk factor for acquiring HCV infection. The prevalence of HCV infection is high in patients with ESRD, on hemodialysis ranges from 6% to 60% in different parts of the world. Several studies show that patients on hemodialysis have an increased overall mortality risk if they have chronic HCV when compared with those on dialysis who do not have HCV. Antiviral treatment in CKD patients can be complicated because many of the agents used for anti-HCV therapy can accumulate to toxic levels in the setting of renal impairment. Treatment of HCV compensated cirrhosis with the new DAA therapy Qurevo “ombitasvir/paritaprevir/ritonavir” with ribavirin in ESRD was approved in many countries. Aim of the study To evaluate the efficacy and safety of Qurevo/Ribavirin regimen in ESRD Egyptian patients who are infected with hepatitis C virus (HCV) . Patients and Methods A prospective cohort study evaluated the outcome of 12-week ombitasvir (NS5A inhibitor)/paritaprevir (NS3/4A protease inhibitor)/ritonavir with ribavirin combination therapy for 50 ESRD patients with HCV at the hepatic virology clinic at Ain Shams University hospital over a period of 15 months (from December 2016 to February 2018). The primary endpoint was sustained virologic response 12 weeks after therapy (SVR12). Results 50 ESRD patients with a mean age of 51.4 years, range from 23-77 years were enrolled.The SVR12 rate was 96% (48/50); 2 patients had virologic failure. As regards adverse events, the most frequent was fatigue/asthenia in 44 patients (88%) and worsening anemia (Hb dropped to < 10 g/dl) in 42 patients (84%). GIT upset occurred in 10 patients (20%), sleep disorders in 8 patients (16%), decreased appetite in 8 patients (16%),respiratory distress in 6 patients (12%), headache, dizziness in 6 patients(12%). Muscle spasms in 4 patients (8%). Itching(pruritis) occurred in 3 patients(6%).2 patients (4%) were non-responders to treatment and another 2 (4%) were relapsers.Death occurred in 4 patients (8%) due to myocardial infarction, pulmonary edema, severe hypotension on hemodialysis sessions, shock due to blood loss in retroperitoneal hematoma following peritoneal dialysis. Hepatic decompensation, hypersenisitivity (angioedema), teratogenicity and drug interactions did not occur in any patient (0%).Other events occurred in 11 patients (22%). They were parenchymal liver changes in ultrasound at the end of therapy after being normal before therapy (in 3 patients), thrombocytopenia, increased alkaline phosphatase, hiccough, deterioration of hypertension, urinary tract infection, lower limb cellulitis, vaginal bleeding, chest infection(in 1 patient each). SVR12 was achieved in 100% of patients who had to stop or modify ribavirin dose;this means that Ribavirin absence didn’t affect the sustained viral response in these patients. Conclusion Our results confirm the efficacy of Qurevo “ombitasvir/paritaprevir/ritonavir” with Ribavirin combination therapy in ESRD patients with HCV infection, with anemia as the most frequent adverse event.